The 5 most important points about ACL or knee surgery
- Completion of an intensive 5-6 week exercise program before surgery can help improve outcomes post surgery.
- This program may also determine whether you require surgery or cam manage without.
- The most important aspect in successful ACL / Lower limb rehab is a consistent approach to a comprehensive program that is designed towards your needs and goals.
- You can get back to sport but this will take up to 9-12 months to ensure long term success.
- If you look after your knee it will look after you.
- This article applies to most rehab of orthopedic lower limb injuries, including hip knee and ankle sporting injuries.
What happens after you have had an ACL reconstruction ?
After you have had your surgery you should start a comprehensive rehabilitation program geared towards your goals.
There is a lot of good research around what makes up a good rehabilitation program and how long each phase will take.
It should involve gym based rehab focusing on improving your strength, power and coordination deficits. As well as sport or task specific exercises and drills.
One of my previous mentors once explained to me that you should be fitter when you finish rehab than when you got injured. So there’s plenty of hard work involved but it should also be fun , you’ve got to have lots of fun.
What should I do if I’m not having ACL or knee surgery ?
Exactly the same as if you were having surgery, although you may find that your pathway is far more accelerated than a surgical knee.
Also if you have ruptured your ACL and yet to have it operated on an extensive pre operative rehabilitation program may identify if you are able to cope without having to go for surgery. There is mounting evidence that those who undergo pre-operative and post-operative rehabilitation have superior outcomes compared to patients who undertake a standard rehab path.
The keys to successful ACL rehabilitation
Looking at the current literature and research the first-line treatment for people following ACL injury should be a comprehensive exercise rehabilitation involving addressing the following areas;
- Range of movement deficits.
- Lower-limb strength (with a focus on quadriceps).
- Neuromuscular control, retraining dynamic balance, jumping and landing techniques.
- Kinetic chain i.e integrating the core, hip, knee and foot function.
- Progressive return to pain-free function and sport.
Back to the gym after ACL surgery, what you need to do .
This phase usually takes place from around week 6 – 8 post operatively. At this point the graft is ready to tolerate more load, the knee should be relatively pain free and have good control and strength for entry level gym based rehab.
If you are going for ACL surgery completing this program before surgery has shown to provide far better post surgical outcomes than those who do not.
What does the ACL rehabilitation program involve ?
These programs initially focus on
- Strengthening the muscles around the hip and knee.
- Neuromuscular control at the hip knee and ankle.
- Training jumping and landing strategies.
Essential exercises for ACL rehab: The first 6 -8 weeks
These are the elements that are important in your rehab from the 6-8 week mark and for the pre surgery component.
The video below is an example of exercises that we may choose for someone in the initial gym based phase of their treatment.
A simple way to do it is pick 2 from each section and follow the suggested rep and set scheme
- Quadricep dominant exercises: 3-5 sets of 8-12 reps
- Deadlifts , Squats and their variations, leg press , Single leg squat , Split squat , etc
- Hamstring and hip dominant exercises. 3- 5 sets of 8-12 reps
- Hip thrust , Hamstring curls, Stiff leg RDL , Hamstring bridge
- Single leg exercises: 3 sets of 12 – 15 reps
- Single leg squat, step ups , lunges
- Entry level plyometric / dynamic balance / agility exercises. 3 sets of 5-8 reps
- BOSU Squats, Skipping, Landing drills, assisted jumping drills
Don’t neglect core strength and ACL rehabilitation.
One area that we add your recovery is an emphasis on lateral core and hip stability in the program. This has been shown to have a very important component in injury reduction especially in sports that require sudden changes in direction.
A stronger core means you can control how your body moves over your knee when the foot is on the ground. So its essential in sports requiring sudden changes in direction e.g netball , football codes , basketball.
We go into more detail about core strength for sport here.
What do you do next after this phase of ACL rehabilitation ?
After 6 to 8 weeks of your gym based rehab journey we need to see how it is progressing regarding strength, power and dynamic control. This involves looking at the functional testing of your knee and how its integrating with the pelvic, hip and ankle complex.
In our next blog we go into more detail on testing and milestones needed to get back to sport and running
If you have had an ACL reconstruction or sporting injury to your lower limb you can book in to see us here
Thanks for reading
Dave.
Failla MJ, Logerstedt DS, Grindem H, et al. Does extended pre-operative rehabilitation influence outcomes 2 years after ACL reconstruction? A comparative effectiveness study between MOON and Delaware-Oslo ACL cohorts. Am J Sports Med. 2016;44(10):2608-2614.
H Grindem1, L P Granan2,3,4, M A Risberg1,5, L Engebretsen3,6, L Snyder-Mackler7, I Eitzen5
How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry